Try this Excel worksheet for generating, organizing, annotating and saving the links within Memoria. It works well, but at this point generated links will need to be cut and pasted directly into the browser. Contact me if you need any help.

Finally, I suggest folks explore the Copyfish add-on to their browser. Voyant offers some great tools for content analysis. Keep in mind that Voyant will only work with electronic or OCR processed text (thus, not directly with a site like Memoria).

History doesn’t repeat itself, but it can be uncannily similar. In 1849, a strange disease began to spread among the ships and within the harbor area of Bahia. By the time the Imperial government recognized it as yellow fever, it had spread widely up and down Brazil’s coast. Like the Zika virus (and dengue and chikungunya), yellow fever is spread by the Aedes aegypti mosquito. For the next six decades, Brazilians suffered enormously from yellow fever epidemics, although there were clusters of epidemic years and sometimes as much as a decade without many cases. The disease was mostly concentrated in the larger urban areas of the coast but spread to smaller cities and inland areas. For example, Campinas, a town in the São Paulo highlands that was not far from the rapidly expanding coffee zone and a magnet area for European migrants, was struck by a horrendous yellow fever epidemic in 1889. Only by the first and second decade of the 1900s, and after scientists discovered the disease vector was the this mosquito (rather than miasma, or vitiated air), did Brazilian public health officials begin to make progress in diminishing this disease through vector control. Brazilians put great effort into vaccines as early as the 1880s, but a yellow fever vaccine was not developed until 1936 (today vaccine development is still slow, but not this slow).

Oswaldo Cruz and other public health officials orchestrated a wide reaching campaign that sent thousands of health workers door to door and yard by yard to eliminate the mosquito’s breeding ground. The Aedes aegypti usually depends on humans because it does not breed in water that collects on the ground. Human containers such as cisterns, animal troughs, barrels, flower pots, buckets, and tires create idea spaces of its larvae to hatch. By sealing, removing, or treating this water the mosquito cannot breed and spread the virus. The collective health campaigns in Brazil’s cities were often quite effective, and the number of yellow fever cases in cities like Rio de Janeiro fell from several thousand to less than a hundred in only two years. Unfortunately, yellow fever has a sylvatic or jungle cycle, reproducing among other species of mosquitos that live in the forests. For this reason, the disease cannot be eradicated, but removing the urban vector greatly improved public health in Brazilian cities by 1915.

Breeding sites of the Aedes egypti

Today there is global attention on the likely link between microcephaly and the Zika virus. Many articles erroneously miss the fact that its disease vector, the Aedes aegypti, typically breeds in artificial containers found in people’s yards. Additionally, the attention is often on developing a vaccine, a prospect that is unlikely to occur soon. Taking a lesson from the past, Brazilian officials are correct by putting their energy into vector control, although insecticides may be less effective than some hope. By reducing this mosquito from urban areas, not only will Zika be diminished, but also dengue, another serious (and relatively new) problem in Brazil. Another option is to suppress the mosquito population through genetic manipulation. Geneticists may insert genes into mosquitos so that the offspring of male mosquitos die before adulthood or female mosquitos cannot fly and therefore breed. This strikes most people as risky and scary, but there is little evidence that “frankenmosquitos” will take over the world, especially since these manipulations are not transmitted. I am disheartened to see the rumors circulating, in some cases among major (tabloid) newspapers such as the UK Mirror, that genetic manipulation of mosquitos is causing Zika, a mistruth that may prevent an effective vector control solution to several dangerous diseases.

I write from an Amtrak on my way to Yale University for this this year’s AAHM conference. On Sunday I will present a paper for a panel titled “Medicine, Disease, and the Framing of Race in the Slaveholding Atlantic” with two colleagues I admire greatly, Stephen Kenny (University of Liverpool) and Rana Hogarth (University of Illinois). I make the claim that Latin America experienced a significant and shared epidemiological change during its first century of independence. Using a case study of smallpox in Brazil, Latin America’s (second) “era of epidemics” may have had more profound consequences than we realize. A paper draft is here.

Historians of medicine often consider nosology, or the classification and naming of disease, to be culture-bound and ethnocentric. For example, Charles Rosenberg and Janet Golden write that “in some ways disease does not exist until we have agreed that it does, by perceiving, naming and responding to it” (1992, xii). InIllness as a Metaphor, Susan Sontag describes the powerful ways that the meanings of particular diseases expand and take mythic proportions far removed from any biological operations on the body. For many Brazilians living in the middle of the nineteenth century, diseases like cholera and yellow fever were indeed metaphors of filth, bad odors, and pollution. Until their microbes were discovered in the late 1800s and the idea of germs became popular, medical and ruling elite understood these two diseases as caused by similar filthy conditions: Rotting and noisome organic material that exuded dangerous gasses and were the catalysts of disease. Physical weaknesses and behavior prone to moralizing, such as intemperance, could predispose infection as well.

History and culture certainly matter because the environmental etiology of many so-called infectious (i.e., miasmatic) diseases was a European colonial and ideological import into the Americas, conceived of by the ancient Greeks and renewed by writers such as Robert Boyle (1627-1691) and Edwin Chadwick (1800-1890). The neo-Hippocratic emphasis on the environment of disease and “unsanitary” conditions in the eighteenth and nineteenth centuries provided a useful framework for making sense of yellow fever and cholera, but we go too far to say that this dominant paradigm was the reason why Brazilians identified cholera and yellow fever in the first place. When these two diseases unexpectedly appeared in Brazil in destructive waves of epidemics in the 1850s, they were perceived as new and unique diseases to Brazil regardless of whether they were caused by (generally preventable) accidents of local environmental degradation, the wrath of God for a people’s sins, the multiplicity of factors within diverse etiological understandings by indigenous and Africans, or a combination of these various perspectives.

Diario de Rio De Janeiro, 23 March 1850, pg. 1

The ways that environment and ecology can “frame” culture, or at least strongly influence beliefs about the operation of the natural world is at the heart of my book project. Historians of medicine usually emphasize the opposite, or the ways that culture frames diseases. But when the epidemiological environment changed drastically in Brazil and horrifying epidemics struck and killed hundreds of thousands of people throughout the country in the 1850s, categories of disease altered as much in the face of a new ecological reality as they did by views of infection and contagion that shifted in interconnected ways across the Atlantic World. In other words, cultural categories matter, but so do the profound changes in the relationship between people and microbes.

One way to explore this idea is to examine how Brazilian newspapers printed particular words across the wide expanse of this continental country and over time. Using the Brazilian National Library’s online newspaper database, it is possible to compare the frequency of any word or combination of characters. I use a “frequency score” that places the three most common three-letter words in the Portuguese vocabulary (“que,” “por,” and “dos”) as a baseline. The usage of these popular words do not appear to have changed greatly and an average of the three reduces fluctuation. A frequency score of “10” indicates that the average usage of the three short common words was about 100 times greater than the frequency of the word measured. Likewise, a score of “100” signifies there are about 10 of each of the three commonest words for every single instance of the word measured. The frequency score, therefore, allows us to find the relative use of a term regardless of the fact that the total number of pages and words printed on each page altered decade to decade.

For example, the words “cholera” and “morbus” went from very rare to common in newspapers across the empire between 1800 to 1879. Their peaks occurred in the 1850s, precisely when cholera took the most lives in Brazil:

“Cholera” or “cholera morbus” referred to a dangerous physical affliction typified by frequent diarrhea and vomiting, dehydration, “rice-water” dejections, and grayish-bluish skin. “Colera” – without the “h” – had a different meaning and is synonymous with “anger” or “rage.” It was often connected to the divine action, such as the “colera de Deus” or “God’s wrath.” This word also became more common in Brazilian newspapers, but its rise preceded the appearance of “cholera” and its more frequent discussion in Brazilian newspapers. I'll come back to this interesting pair of homophones.

We can also see an increase in words relating to the intensity and destruction of disease. Three words: “epidemia” (epidemic), “peste” (pestilence or plague), and “flagello” (scourge or plague) demonstrate shifts in usage:

Again Brazilian newspapers increasingly print these words, with a peak during the 1850s. These words were also used in reference to other epidemics of the day, including yellow fever and smallpox. In fact, yellow fever was a worse problem in the 1850s and 1870s, and this may explain the dip in these terms’ usage in the 1860s. “Peste” and “flagello” have more religious connotations, and can infer the actions of a Christian God reacting to a people’s moral behavior. The fact that “epidemia” surpassed these two words at this time may hint at a secularization of society. The historians João José Reis and Claudia Rodrigues present strong evidence that burial traditions also demonstrate a steady secularization in the 1800s, especially at the moments of these outbreaks.

In all cases, the increasing use of these words corresponds with sharp rises in the mortality and destruction of several unfamiliar diseases (cholera and yellow fever) or familiar but worsening diseases (smallpox). Some may argue that use of language, and the cultural categories it expresses, was driving the perception of these diseases. This might be partially true. For instance, when cholera’s homophone “colera” became more commonly printed in Brazilian newspapers, did it make the arrival of “cholera” a more fearsome event because a conscious or unconscious association with God’s wrath? From the movement of these charts, however, it appears that language was largely reactionary. To put it another way, when these diseases arrived, people talked more about them, but in ways that shifted gradually over time.

I leave for Oxford UK today to present at the Society for Social History of Medicine. My paper makes several arguments related to Brazil's worst epidemic. First, it confirms the finding made by Donald Cooper and a few other historians that white people faced fewer risks from the cholera epidemics (1855-59, 1861-68). Cholera disproportionately killed slaves, but also free blacks, thereby exposing structural racism in Brazil. Second, cholera allows us to understand race relations and ideology because unlike the United States, Brazilian elite did not rely in race essentialism to explain the unequal risks. Nor did people of color rely on organized agression to justify their calamity even though unequal risks were apparent. Like Richard Evans has found for Europe, cholera sparked no flames of revolution. Finally, I present evidence that cholera should be included as one of several factors that contributed to regional inequality in the twentieth century. The fact that the Brazilian northeast is much poorer than the Brazilian southeast was much more related to the "commodity lottery," changing fortunes of global commodity prices, and international migration patterns, but cholera should not be overlooked. For every 12 slaves that died in the northeast during the two cholera epidemics, only one slave died in the southeast. This had much more profound effects on the regional economies than historians have recognized. The full paper is here.

The Brazilian Northeast suffered far more loss of life and costs from cholera in the nineteenth century than any other region of Brazil. According to the official government report, 30,000 people were killed in Bahia between 1855 and 1856, more than any other province. Cholera continued to infect people in the Northeast from 1857 to 1860 and 1861 to 1867, although with less severity in most places.

Asiatic cholera (as opposed to "sporadic cholera") was first diagnosed in Salvador on 21 July (although there are some clues it arrived earlier). Between the end of July and September, the disease spread throughout the Bahian Recôncavo, a relatively densely settled agricultural zone surrounding the All Saint's Bay (Baia de Todos os Santos) where much of Brazil's sugar and tobacco was grown.

There is little doubt that that steamships caused the early diffusion of cholera in this important region. In 1855, the company Bomfim operated four steamships under government subsidies. These steamships departed Salvador and made two trips a week to Santo Amaro, São Franciso, Cachoeira, and Maragogipe; one trip a week to Nazareth and Jaguaripe; and one trip a month to Valença. Among the first cities to report cases of cholera outside of Salvador were Santos Amaro, São Francisco, Cachoeira, Maragogipe and Nazareth. Cholera also arrived in Jaguaripe and Valença earlier than most other Bahian towns. Bomfim expanded its steamship service only a few months before cholera arrived in Bahia. Officially reports do not connect cholera and the steamships probably because the elite hoped to expand navigation for commercial purposes, not call on its epidemiological risks.

From each of these steamship ports, the disease spread outward, so that by the end of August, people were dying of cholera in nearly every town and village on the shore All Saint' Bay, its major river tributaries, and deep into the inland farming zones. I am exploring the economic impact of cholera. For example, the Bahian president reported that large sugar plantations in places like Iquape lost 20-40 slaves from the disease, ending or greatly diminishing production.

Donald Cooper, Professor Emeritus of Ohio State University, gave me his only copy of a 73 page bibliography of works mostly related to the history of disease and medicine in Brazil. Professor Cooper worked for several decades of work to document the history of yellow fever and, in the process, he amassed one of the largest and best collections on the history of medicine of Brazil. Much of this material is now in OSU's Special Collections (See this previous post for more information). Because Don could only give a printed version of his bibliography, we've OCR processed it to make it searchable. Researchers looking for a comprehensive list of works on this subject should consult this bibliography and the bibliography and holdings of the Archive of the Casa de Oswaldo Cruz.

Between April 1865 and April 1867, several thousand soldiers began a slow journey over the hills and through the forests of southern Brazil. The men, part of the Mato Grosso Expeditionary Force, had been ordered by Brazil's Emperor to march west to fight the Paraguayan army on behalf of their nation and allies, Argentina and Uruguay. But they had to get there first, and 3,000 kilometers of rough terrain separated them from their enemies. The soldiers traveled by river when possible, or took trails traversed by the indigenous, traders, and adventurers of Brazil’s remote western frontier. The journey, taking two years, was greatly slowed by what the soldiers brought: heavy artillery, ammunition, supplies, and a herd of cattle over paths that were often too narrow, too muddy, or frustratingly obstructed by steep hills, wide rivers and malarial swamps. They stopped more than they moved. In such pauses, soldiers surely talked about the much easier and faster route to their destination. Some, in fact, may have already traveled to Mato Grosso by sail or steam down the Atlantic coast, into the Rio de la Plata and up the Paraná or Paraguay Rivers; a two month journey. The ship route, however, had been blockaded by Paraguayan forces by the time the expedition set out for Mato Grosso. Furthermore, officers spoke of the need to repel a malevolent invasion and to compromise their enemy’s defenses by creating a new northern front.

When the column arrived after their arduous journey, they were weak and ill-prepared. Several early battles turned against them and they retreated into Brazilian territory, pursued by Paraguayan cavalry regiments. Soon, however, they had to contend with a new and even more frightful enemy that took no visible form and used no bullets to fell the fiercest warrior. On May 18th, pained cries were heard from three soldiers struck by cholera. Two days later the disease had spread so rapidly that the column’s carts and wagons filled with deathly ill soldiers. The epidemic prevented the Brazilians from finding a suitable defensive position against Paraguayan forces, whose continued attacks drove the column through jungle and brush, deeper into their heartland. To prevent total loss, officers ordered the sick abandoned and once tied a large sign from a tree branch asking mercy for the infirm.[1] Of the original 2,700 soldiers of the Mato Grosso Expeditionary Force, only 700 made it to safety at the Aquiduana River. More soldiers had died from disease than from enemy bullet or blade; in addition to the havoc wrought by cholera, there were a host of other dangerous afflictions, including other gastro-intestinal illnesses, smallpox, and malaria.[2]

This tragic episode, called the Retirada da Luguna (Retreat from the Lagoon), became a popularly recounted story of bravery against all odds to Brazilians. Although Brazil and its allies won the war against Paraguay in 1870, victory came at an awful cost, leading the Imperial government to lose legitimacy and fostering foundational support for a republican movement that eventually toppled the monarchy. The loss for Paraguay was even more severe: The government was overthrown, the army destroyed, and between one third and one-half of the nation’s total population was killed, including most working age males. Beyond a symbol of tragedy and heroism, the Retirada also demonstrates how the epidemiological environment of a wide region of the southern interior of South America was disrupted by the importation of epidemic diseases. Like most other wars of the nineteenth century, more soldiers were killed from illness than enemy combat in the Paraguayan War. And as in the Crimean (1853-56) and Austro-Prussian (1866) Wars, cholera may have been the top killer. Historians know little about this disease and the role it played despite the damages it wrought. Important yet unanswered questions include: Who or what carried the vibrio cholerae into the theater of war? How long did it persist? What was morbidity and mortality of the outbreak or outbreaks? Did cholera affect one army more than the other, perhaps quickening or delaying the Allied victory? What was the effect of imported diseases on the wider region? While more comprehensive answers will come with the publication of Brazil’s Era of Epidemics, some clues to help understand the context of the war and cholera’s impact and be found by clicking here.

[2] In May and June, the final months of the operation, 30 soldiers and officers were killed in combat. Ten times as many were killed by cholera. Jourdan, E. C., Historia das campanhas do Uruguay, Matto-Grosso e Paraguay (Rio de Janeiro: Imprensa Nacional, 1893) 103.

Cholera was carried to northern Brazil in May 1854, infecting many parts of the coast by the end of the year. See an earlier post on its spread. Several regions were struck the hardest, with mortality rates exceeding 10 percent. One such place was the southern province of Rio Grande do Sul and its capital, Porto Alegre. Municipal inspectors reported mortality rates from various parts of the city and these data were compiled by the Provincial Government and published as a set of tables. We visualized mortality data by city blocks in the map above with red dots that represent parts of the city where cholera mortally rates were the highest, or with blue dots, where it was the lowest. More precisely:

Data were reported by quarteirões, or city blocks, which imperfectly aggregate dissimilar parts of the city. Nonetheless, the pattern that emerges suggests that cholera killed more people living in the lower elevations closer to the water’s edge of Guaíba Lake, particularly on the northern end of the city. The map below (which has been turned for visual alignment) gives some general contour lines. By comparing these two maps, we can see that those living on higher ground, slaves and free, may have faced a somewhat smaller risk of this water born disease. Elevation has been shown to be an important factor in recent cholera epidemics, according to a study of epidemic cholera in Harare, Zimbabwe.

I wouldn't be using this space well if I didn't make at least one plug for my new book The Hierarchies of Slavery in Santos, Brazil: 1822-1888, (Stanford University Press, 2011) The book argues that slavery was hierarchical and slave opportunities for action often dependent on their position and the prestige of their owner. We typically think that all slaves were treated with equal brutality, but this was certainly not the case. In Southeastern Brazil at least, doors opened or closed for all kinds of important opportunities -- including freedom -- at different times for different slaves. Slaves of wealthy owners may have faced some greater hardships (i.e., stricter observation, more jailtime for offenses), but they were often more likely to receive medical attention and live in more comfortable settings. Slaves, of course, were not oblivious to inequities within bondage. I believe this tempered some rebelliousness slaves felt toward the institution as a whole. If life offered "opportunities" within slavery and it was obvious that some slaves had received "breaks," then the incentive to collectively push against the institution as a whole diminished.

It was this research that turned my interest toward the medical history of Brazil, since Santos remains infamous in Brazil for the scourges of yellow fever and smallpox that devastated the port city during the late 1800s. Santos was a dreaded place to navies when thousands of foreign mariners died in port each year. Chapter five of Hierarchies of Slavery discusses health conditions, medical treatment, epidemics and slavery.

Please consider buying this book. Doing so won't make me any money, but it will reduce the pressure that academic presses now face to induce expensive "subsidies" from their authors. We need academic presses to remain economically viable since primary research brings large profits, but not usually the monetary kind.

A series of unfamiliar and devastating epidemics struck Brazil in the second half of the nineteenth century. These epidemics had a profound impact on Brazil’s political, economic and social development when the boundaries of deadly and frightening scourges of yellow fever, cholera, malaria, bubonic plague, and smallpox shifted across national boundaries. These diseases altered because of intentional human action (i.e., smallpox vaccination campaigns), but more frequently changed because of unintentional actions (agricultural drainage and nutritional improvements decreased malaria incidence) or non-human habitat changes (the distribution of aedes aegypti mosquitoes, the vector of yellow fever, altered). This project places Brazil’s “era of epidemics” (1849 – 1910) within a broader context of 1) divergent hemispheric development and 2) pathways for disease movement. The nineteenth century was, after all, a time of clipper ships, packet boats and steam engines, and the Atlantic and Pacific Oceans composed the wider region’s primary passageway for the increasing flow of goods, people, and microbes during the second half of the nineteenth century.

In a week I’ll present a paper at a historical conference that smallpox became a much bigger problem throughout Brazil during the second half of the nineteenth century. I estimate that more than one million Brazilian were killed by smallpox between 1850 and 1900, more than those killed by the other increasingly fearsome diseases of the day (cholera and yellow fever) and more than those killed by smallpox before 1850 and after 1900. That smallpox worsened in Brazil is not a well recognized fact.

In São Paulo and in other parts of Brazil, smallpox epidemics increased in frequency after 1850. In the table below, we see outbreaks as they were reported by the annual São Paulo President’s and Governor’s Reports. Some years, São Paulo’s provincial president vaguely described smallpox as occurring “throughout the state,” but it is unlikely that every or even most township had outbreaks those years. in the 14 years between 1837 and 1850, there were four epidemics. In the 14 years that followed, there were nine.

In some places, such as Santos, smallpox mortality rose until the 1880s, before declining (see figure below). Epidemics, however, became more virulent until the 1890s, before they largely vanished due to far more effective and financed public health efforts under the new Republican government. Similarly, in Rio de Janeiro, smallpox epidemics became more frequent and general mortality increased until the 1880s, before declining. Rio de Janeiro experienced two terrible outbreaks of smallpox in 1904 and 1908 during a decade when São Paulo suffered no major epidemics. This was an eradicable disease: European governments had begun greatly reducing the threat of smallpox as early as the 1830s.

I plan to discuss how railroads facilitated the spread of smallpox. In the map below, we can see various township centers connected by the railroad (grey line). The red circles indicate epidemics that occurred between October and December, 1892. Township centers without railroad states, including Tieté, Porto Feliz, Cajurú, Riberão Bonito, Socorro, Serra Negra, Caconde, Nazare Paulista (Nazareth), Maripora (Jaquery) and others, avoided this disease.

Other factors that may have prompted the spread of smallpox include large populations, large population growth (between 1872 and 1890), or proximity to navigable rivers. In the final table we can see that the size of the population mattered, but there was a larger correlation between railroad stations and smallpox epidemics.

Contemporaries were not blind to the fact that trains carried smallpox and, in fact, stations were closed when epidemics occurred. Three local outbreaks reported by the Diário Official do Estado de São Paulo in 1891 occurred within walking distance of the train stations in São Paulo, Bocaina, and Conchas.

This is not the only disease that railroads helped make into a worse problem. In 1889, yellow fever appears to have been greatly aided in spreading to “virgin soil” populations in interior São Paulo, devastating towns such as Campinas (see my previous post). Railroads may have accelerated growth in Brazil, but historians who have estimated savings brought by railroad building have not yet included the enormous costs of these two contagious diseases.

This is the first time we can visualize smallpox as it appeared and shifted in form in Imperial Brazil. Smallpox was no minor concern: it was the most destructive and feared disease across much of interior Brazil. In its most virulent form, smallpox killed one in four infected, usually as a result of internal bleeding. In its mildest form, it stole vision and beauty from the faces it touched. As a pathway to death, smallpox is overtly undescribable, yet it occurred with such frequency to leave a widespread and profound sense of its power. And it had a noticable personality, for unlike the other top killers of the day, it picked its victims from all kinds of people, not discerning pampered rich boys from slaves outcast at old age.

Considering its importance for day-to-day life in Brazil, it is remarkable that we know so little about it. Were people helpless? Did the Emperor, provincial presidents and town mayors not fight back? Remember that this was the only major disease that European governments and charitable organizations had successfully resisted through public health programs and stringent laws as early as the 1820s. Did Brazilians organize and finance institutions to provide vaccination for those who needed them? Historians have guesses (i.e., the imperial government was too weak and poor), but few firm answers.

I'll be putting more up as things develop. For the full series of maps, please click here.

UPDATE: This research behind this post was revised, expanded and published here.

Figure 1.

Figure 2.

Figure 3.

Because tetanus mostly strikes newborn babies whose umbilical stumps become infected through unhygenic post-natal care, this disease is a unque indicator of medical treatment and life conditions.

These three graphs demonstrate that tetanus, a frequent killer in the 1850s, become a rare disease by the 1890s in the large southern Brazilian city of Porto Alegre. For a description of tetanus and this current project, see my earlier post. As seen in Figure 1, infant mortality also declined (at least in relation to deaths of other age groups). This gives us strong evidence that as tetanus disappeared, newborns had a greater chance of living. Interestingly, tetanus among slaves showed an opposite trend, as we can see in Figure 2. Between 1850 and 1870, tetanus increased as a cause of about 3 percent of total slave deaths to 5.5 percent. This may have been a consequence of the end of the international slave trade in 1850 because after this point, the male to female sex ratio fell and, possibly, more slaves had chidren. But as an aging population, I would expect to see a falling percentage of tetanus deaths since this group was much older on average and less prone to infantile afflictions. Data from Santos shows tetanus rates falling even among slaves during this same period so it may be simply that conditions and treatment of slaves in Porto Alegre worsened despite their rising price. I excluded data after 1871 since all babies born to slaves were legally free in Brazil when the Imperial government passed the "Free Womb Law" in 1872. Figure 3 demonstrates that even though relative rates of tetanus may have been on the rise among slaves, by the 1890s -- after slavery was abolished -- the gap between the (wealthier) white population and the (poorer) "people of color " (i.e., pretos, pardos, morenos, etc.) vanished. This is another surprising finding since most historians assume that whites continued to recieve superior medical treatment compared to non-whites.

Data is taken from 46,254 free people and 6,739 slaves who were buried in the cemetery of the Santa Casa de Misericordia in Porto Alegre between 1850 and 1898.

For a short discussion of possible bias in the obit data of tetanus deaths, view this.

"One way to address and analyze the impact of Brazil's Era of Epidemics on public policy, overall population welfare, changes in treatments, and other areas of interest is to compare the Brazilian context with the epidemic context of another large country in the Western Hemisphere: the United States. This blog post will summarize existing historiography of U.S. health related to infectious diseases in the second half of the nineteenth century. Since the focus is on infectious diseases with epidemic potential, this review has a more narrow scope than U.S. health historiography generally for the period. Many studies exist on mental health, chronic disease, cancer, heart disease, and other health concerns in the nineteenth century; their exclusion here does not necessarily reflect a small place in the literature. Studies conducted by demographers, geographers, and economic historians also have a big presence in this review because their methodologies often analyze mortality.

Existing research, as may be expected, generally follows the existing sources. Census data years, military records, especially concerning Civil War soldiers, surveys of cities like Philadelphia with early vital statistics record-keeping, and hospital data all dominate the literature on non-slave populations. Slaves welfare has a large place in the historiography which is discussed in detail below. I will begin with a summary of..."

Click here for the rest of this excellent historiography by Glynnis Kirchmeier.

Tetanus has become the latest focus of the EE project. This disease is usually the result of a wound infected by the Clostridum tetani bacteria. As this microbe multiples it release a neurotoxin that can quickly become fatal if untreated. Poisoning is accidental, since the nuerotoxin is a natural byproduct of its life cycle. It is a terrible accident, though, since it causes spasms and tightened muscles, especially around the jaw (hence its older popular name "lock-jaw") and back (called opisthotonos, see image). One of its most tragic manifestations is neonatal tetanus, usually due to an infection at the umbilical stump caused by a dirty cut or contaminated poultice. In some parts of Brazil as many as one out of three infants died from neonatal tetanus. Millions of mothers and fathers watched their newborns stop feeding and arch in pain for days before dying.

I have only just begun to look at the data, but so far I have found a large drop in in the incidence of neonatal tetanus around 1890 in some parts of Brazil, right around the time that European and Japanese doctors discovered and isolated the tetanus bacteria. As the same time, there are still a sufficient cases of neonatal tetanus in the early 1900s, indicating that asceptic practices were uneven. What fascinates me about this disease is how connected it is to medical practice and belief. By understanding the history of tetanus, we will have a much better idea of how foreign medical knowledge disseminated in Brazil and how quickly medical and midwifery practice changed. A fuller description of this research can be found here.

Glynnis Kirchmeier, a former student of mine at the University of Puget Sound, has been an enormous help to the EE project by gathering material related to the history of health and disease in the United States during the nineteenth century. While little is known about general patterns of health during this time, most evidence points to improvements in mortality for Americans. By comparing the US and Brazil, we hope to get a better idea of hemispheric trends. For example, in Brazil during the 1800s, some important diseases became more serious threats, including yellow fever, cholera and bubonic plague. Except for yellow fever in the southern United States, the opposite seems true for these three diseases in the US. Here are details on relevant articles and graduate theses. These will be updated as it is expanded.

I hope this video, shown recently at BRASA, gives support to several arguments. The first is that yellow fever most likely appeared in Brazil in 1849 (for the first time in 157 years) because it was transported on ships carrying migrants on route to mine gold or settle in California. Contemporaries blamed a ship arriving with 49ers as the cause of the outbreak in Bahia, but this is not widely known or discussed by historians today. In fact, historians more commonly connect the slave trade with the outbreak of yellow fever, although this seems improbable for reasons that I'll save for another post.

Second, yellow fever moved inland both in the United States and Brazil with the help of steam propelled riverboats and locomotives. See my previous post for evidence that it also followed railroad routes.

There is an important implication to the disease's dramatic movement. Yellow fever, cholera and bubonic plague were all absent in Brazil during the first half of the 19th century, but caused hundreds of thousands of deaths during the second half. Smallpox also worsened in mortality, killing millions. For the United States, all of these diseases except bubonic plague were present, but were worse during the first half of the century. Therefore, we should include the changing epidemiological environment with geography and institutions as the main reasons why the development gap between these two countries widened between 1850 and 1900.

The last argument was methodological, and I hope it became apparent in the video/slide show. I believe that visually representing spatial data not only gives us the tools to make connections we might not have made otherwise, but it helps build support for our arguments. It is one thing to say that steamboats preceded outbreaks of yellow fever on the Mississippi, São Francisco and Amazon Rivers, but another thing to show the arrival of the steamboats and outbreaks on a geocoded map changes over a set time period.

Many of the day-to-day affairs of the Brazilian Empire (1822-1889) were overseen by the Ministerio do Imperio (Ministry of the Empire). Once or twice a year this Ministry published an update of the Empire's state of affairs, including reports on schools, municipal elections, and the imperial family. These reports are valuable for this project because they became increasingly detailed in their discussion of public health following the outbreaks of yellow fever and cholera in the 1850s. By the 1860s, they included special reports written by Brazil's top health authorities. Beyond health, historians studying education or searching for details on some of the smaller provinces will also find them to be a rich primary source.

Ministerial Reports are one of the most accessible primary sources for the imperial period because they can be read online though the Center for Research Libraries (CRL) website. The CRL does an invaluable service making these available without any special licence or access. Historians are limited by this source, however, by their length (as many as 1000 pages for some in the 1870s) and the lack of detailed index. Furthermore, the CRL only holds page images that have not, until now, been OCR processed. Without machine readable text, they cannot be searched, making the task of finding answers to specific questions much like finding a needle in a haystack.

I've been working with my father for more than a year now to make part of the enormous collection of government documents at the CRL searchable. My father created a web-based program that runs on a Linux server and uses MySQL to store and retrieve text records. A separate Python program processes the OCR text information and organizes it in the MySQL database. This technology allows anyone with an internet connection to be able to search the Ministry of the Empire reports by keyword or character combination here. In total, there are 19,640 pages from 60 reports covering the period 1832-1888.

One caveat: Often the image or text quality is so poor that our OCR program (AABBY) couldn't read the text correctly. This means that there are many misspelled words or misidentified characters. Working around this problem, we included regular expressions searches, a powerful way to find words using wildcard characters or other expressions. We've also included a quick link to a specially created .pdf page and the CRL's page image for each returned search hit, and these are often easier to read.

Eventually we would like to expand to include more reports. Even though this could be done for a relatively small price, the cost for us at this point is prohibitive. We are looking for sources of funds that could make this possible and are open to any ideas. Potentially, the program's use could be greatly broadened because it could provide a search engine for other primary sources that have been OCR processed.

I've been looking closely at the hemispheric distribution of yellow fever during the 19th century as part of research for an upcoming conference. Using several secondary sources that list outbreaks of yellow fever in the United States, I created a map that shows yellow fever in the United States from 1790 to 1910. I've done this before, but in less detail.

A few things stand out in this map. First, yellow fever left its greatest mark on the eastern seaboard and, especially, in the northeastern ports between 1790 and 1820. After this period, it lingered in this area, but also expanded southward, mostly in the Gulf Coast region. During the 1810s, it took root in and near the Mississippi delta. Yellow fever appears to become endemic in New Orleans. By the 1820s, it slowly but erratically spread up the Mississippi River. The Texan Gulf also had a first outbreak. By 1854, yellow fever was now a “southern” disease, with periodic outbreaks in the gulf and delta areas especially. The 1878 epidemic was memorably severe in how far it spread inland (more on that in a minute) and high levels of mortality. There were fewer epidemics during the 1880s, but yellow fever returned with virulence in the south in the 90s. After 1901, health officials learned that yellow fever was transmitted by the (aedis aegypti) mosquito and in the next few years health boards attempted mosquito larva eradication programs. Such programs diminished but did not halt the last major epidemic, in 1905.

I'm building a similarly detailed map for Brazil, but this is a more difficult task because far fewer historians have collected yellow fever statistics. But from what we know, yellow fever and its mosquito vector shifted considerably in its range. For instance, in São Paulo during the 1850s, the disease was almost entirely confined to the coast and only took its victims from an area not far from the international port at Santos. Even though the coffee boom in the following decade brought many more ships, non-immune European sailors and immigrants, yellow fever had largely vanished. It returned in 1870 and began to spread inland. By 1889, yellow fever mosquitoes had crossed the tall mountain range and entered the Paulista highlands, where thousands of coffee trees were producing most of the world’s coffee, bringing new wealth to Brazil. Epidemics occurred in coffee towns previously thought to be immune to the fever until 1903 when the last major outbreak occurred in Riberirão Preto.

This changing distribution of the disease in inland US and Brazil was largely caused by railroad cars that transported infected insects and people into areas with low levels of immunity. In the two maps below, we can see that the outbreaks in Texas (1862-73) and São Paulo (1889-1903) usually occurred near the railroads. In fact, Houston and Campinas were both hubs of two strikingly similar disease networks. Residents were well aware of the threat that this new technology brought, and in both instances, the railroads were closed during (but not before) some of the worst epidemics.

Although there is little doubt that transportation technology like railroads and riverboats contributed greatly to the expanding and changing distribution of yellow fever outbreaks, it is much harder to explain why yellow fever shifted from the American east coast to the south and why yellow fever was not even present in Brazil between 1693 and 1849. Furthermore, yellow fever epidemics were less common in both countries during the 1860s and 1880s than the 1850s, 1870s and 1890s. I believe that these changes were caused not by something that people did, but by naturally shifting boundaries of the mosquito host.